Who is accountable for the young woman dying during childbirth in a hospital in Lusaka, Zambia? For the woman in a health center in Bugiri in Uganda? For the girl child in a rural home in Uttar Pradesh, India? In a shanty town in Tegucigalpa, Honduras? Who is accountable for the women and adolescent girls in a thousand places everywhere?

Late one April night in 2012, 19-year-old Ilionelle was struggling to give birth at her home in rural northwest Haiti. After several hours, she began having seizures, a clear indication of eclampsia, a severe medical disorder that can lead to the death of the mother and/or baby.

Ilionelle’s situation is not uncommon in Haiti, which has the highest maternal mortality rate in the Western hemisphere with 630 deaths per 100,000 live births. Fortunately, Tilma, the traditional birth attendant helping Ilionelle, quickly identified these life-threatening symptoms and arranged for her transport to Beraca Hospital for emergency obstetric care. After being carried on a stretcher for four hours along a steep and treacherous road, Ilionelle arrived at Beraca Hospital where she safely delivered a healthy baby boy. “If it wasn’t for Tilma, both my son and I could have died,” Ilionelle said.

Tilma is among thousands of Haitians working to improve their nation’s health after recent years of misfortune.

On a dark August night in rural South Sudan, Linda Kenneth felt the swift kick of labor pains begin. Having previously delivered five children, Linda recognized the pains and immediately called for the nearby skilled birth attendant, as it was too late in the evening for her to travel safely to the health facility. In her previous two pregnancies, she had experienced heavy bleeding after delivering, and worried similar complications might arise this time.

South Sudan has the world’s worst maternal mortality ratio (2,054 deaths per 100,000 live births), and roughly one third of these deaths can be attributed to postpartum hemorrhage (PPH). Administration of misoprostol or another uterotonic (a drug that reduces bleeding after childbirth) could prevent the majority of these deaths. Misoprostol does not require a cold supply chain, and is cheap and effective, making it a perfect candidate for community-based interventions.

Upon the birth attendant’s arrival, Linda presented the three misoprostol pills she had recently been given by a home health promoter. Several days prior, a home health promoter had visited Linda and discussed with her a birth preparedness plan, informing her of the benefits of taking misoprostol immediately after delivery to prevent excessive bleeding.

All project health indicators for the second phase of the USAID-funded Sudan Health Transformation Project (SHTP II), led by Management Sciences for Health (MSH) in partnership with the International Rescue Committee, have shown improved performance over the past two years.

On the ground, this means that more people are being immunized against diseases, communities are receiving education on HIV, and lives are being improved.